Prostate Cancer Grade and Stage Misclassification in Active Surveillance Candidates: Black Versus White Patients

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  • 1 Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;
  • 2 Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;
  • 3 Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;
  • 4 Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy;
  • 5 Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy;
  • 6 Department of Urology, European Institute of Oncology, Milan, Italy;
  • 7 Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;
  • 8 Department of Urology, Medical University of Hamburg, Hamburg, Germany;
  • 9 Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; and
  • 10 Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
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Background: Misclassification rates defined as upgrading, upstaging, and upgrading and/or upstaging have not been tested in contemporary Black patients relative to White patients who fulfilled criteria for very-low-risk, low-risk, or favorable intermediate-risk prostate cancer. This study aimed to address this void. Methods: Within the SEER database (2010–2015), we focused on patients with very low, low, and favorable intermediate risk for prostate cancer who underwent radical prostatectomy and had available stage and grade information. Descriptive analyses, temporal trend analyses, and multivariate logistic regression analyses were used. Results: Overall, 4,704 patients with very low risk (701 Black vs 4,003 White), 17,785 with low risk (2,696 Black vs 15,089 White), and 11,040 with favorable intermediate risk (1,693 Black vs 9,347 White) were identified. Rates of upgrading and/or upstaging in Black versus White patients were respectively 42.1% versus 37.7% (absolute Δ = +4.4%; P<.001) in those with very low risk, 48.6% versus 46.0% (absolute Δ = +2.6%; P<.001) in those with low risk, and 33.8% versus 35.3% (absolute Δ = –1.5%; P=.05) in those with favorable intermediate risk. Conclusions: Rates of misclassification were particularly elevated in patients with very low risk and low risk, regardless of race, and ranged from 33.8% to 48.6%. Recalibration of very-low-, low-, and, to a lesser extent, favorable intermediate-risk active surveillance criteria may be required. Finally, our data indicate that Black patients may be given the same consideration as White patients when active surveillance is an option. However, further validations should ideally follow.

Submitted December 19, 2019; accepted for publication April 27, 2020.

Author contributions: Content counseling: Stolzenbach, Rosiello, Pecoraro, Palumbo, Luzzago, Deuker, Knipper, Pompe. Statistics: Stolzenbach, Tian. Review: Zorn, Shariat, Chun, Graefen, Saad, Karakiewicz. Supervisor: Karakiewicz.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Lara Franziska Stolzenbach, MD, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. Email: fstolzenbach191@web.de

Supplementary Materials

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